Abstract
Purpose: :
Ocular surface disease with stromal involvement requires both an optical keratoplasty and stem cell transplantation. Penetrating keratoplasty (PKP) is a poor indication due to the high risk of graft rejection, while deep anterior lamellar keratoplasty (DALK) offers full stromal transplantation without the risk of rejection. We report a novel technique using an artificial anterior chamber to design custom-thickness donor buttons and thin limbal rings.
Methods: :
Four eyes of 3 patients with gelatinous drop-like dystrophy (GDLD: 2 eyes), ocular cicatricial pemphigoid (OCP) and Stevens Johnson syndrome (SJS) underwent simultaneous DALK and kerato-limbal allograft (KLAL). All patients had a Schirmer test value of at least 3 mm, and normal lid anatomy. DALK was performed by the viscodissection technique, followed by 360-degree KLAL. Donor corneas were fixed to an artificial chamber to produce thin-section (100 µm) donor limbal tissue. KLAL donors were fixed at the outer rim using 10-0 nylon, which were removed after 2 to 4 weeks to produce a seamless ocular surface.
Results: :
All patients were followed for at least 6 months (average 13 months). A corneal epithelial phenotype was obtained in all eyes, with occasional epithelial defects observed in the SJS patient. KLAL donor tissue adapted to the recipient limbal tissue to recreate a smooth ocular surface, with normal tear meniscus observed in all patients. Visual acuity improved by more than 2 lines of vision in all eyes. No incidence of graft rejection or secondary glaucoma was observed.
Conclusions: :
Artificial anterior chambers are useful in designing donor grafts for ocular surface reconstruction by simultaneous DALK and KLAL.
Keywords: transplantation • cornea: clinical science